Patient Assessment

General Impression

Impression of the patient's condition that is formed on first approaching the patient, based on the patient's environment, chief complaint, and appearance.

The general impression can be formed from the time the call is received until the first few minutes of arrival

Scene Size Up

Upon arrival of the scene the EMT looks for MOI/ISO, number of patients, and if help is needed

Initial (Primary) Assessment

AVPU, CC, ABCDE. Used to find life threatening situations and treat them immediately when found.

General (Secondary) Assessment

SAMPLE, Vitals, and Physical assessment.

This is typically done in the ambulance on the way to the hospital

Ongoing Assessment

Start with mental status (AVPU).

Reassess vitals every 5 minutes for the unstable patient, and every 15 minutes for the stable patient

EMS Report

Give ID, Pt age, sex, CC, vitals, impression, care given, and ETA

Keep conscious and clear

Chief Complaint

Why the person called 911. What is distressing the patient the most

Nature of illness

The general type of illness a patient is experiencing. Similar to the CC (chief complaint)

LOC stands for?

Level of consciousness

BSI Stands for?

Body substance isolation - the assumption that all bodily fluids are contaminated

Paradoxical Motion

When 3 or more consecutive ribs are broken in two or more places making the broken area move opposite of the rest.

Sign of a flail chest

Crepitus

A grating or grinding sensation caused by fractured bone ends or joints rubbing together; also air bubbles under the skin that produce a crackling sound or crinkly feeling.

Edema

Swelling

Ex: Pulmonary Edema = swelling (fluid) in the lungs

Baseline Vitals

The first set of vitals when you initiate care.

Can be used to assess quality and responsiveness to treatments. Answer the question, "is my patient improving after xx treatment, staying the same, or getting worse?"

Vital Trending

Comparison of other sets of vitals to the baseline

Ventilations

The mechanical movement of the chest. We look at ventilations

Respirations

The process of taking in oxygen (inspiration) and expelling carbon dioxide (expiration) by way of the lungs and air passages.

In other words, the process of getting air in and out of the tissues. We listen to respirations

Adult Respiratory Rate

12-20/minute

Child Respiratory Rate

15-30/minute

Infant Respiratory Rate

25-50/minute

Descriptive Words for Ventilations

Noisy, quiet, deep, shallow, normal, effortless

Descriptive Words for Ventilation Rhythm

Just regular or irregular

Snoring Respirations

Tongue has fallen into the airway and is blocking it

Gurgling Respirations

Fluid in the upper airway

Wheezing

High pitched whistling sound that is due to bronchoconstriction.

Irreversible narrowing of the lower airway

Stridor

High pitched whistling heart on inhalation due to a partial upper airway obstruction

Rales

Fine crackling sounds heard on auscultation when there is fluid in the alveoli

Rhonchi

Loud rumbling sounds heard on auscultation of bronchi obstructed by sputum

Just know: fluid in the bronchioles

Wet Lung

Pulmonary Edema

When you feel the pulse, what are you feeling?

The contraction of the left ventricular

Pulse Point

Place where artery may be compressed against bone with fingertips to feel pulse

Pulse checked in unresponsive adults and children

Carotid pulse

Pulse checked in responsive adults and children

Radial pulse

Which pulse do you check in infants

Brachial pulse

Words used to describe heart rhythms

Regular or irregular

Words used to describe the pulse

Strong, weak, thready, absent, bounding

Normal pulse range for an adult

60-100 bpm

For now just know child and infant heart rates are faster

Capillary refill should return when?

Less than 2 seconds

Greater than 2 seconds can mean low perfusion due to low blood pressure

When is capillary refill used typically?

In patients under 6 years of age

When can blood pressure be replaced with cap refill?

Patients under 3y/o

Can be used on adults but may not be as accurate

May not be reliable in warm/cold environments or raising or lowering the body part

Auscultation of blood pressure

Listening to the blood pressure. You obtain a systolic and diastolic value

Ex) 120/80

Palpating blood pressure

Applying a blood pressure cuff and using fingers to feel over the artery while releasing cuff pressure. You only get the systolic blood pressure.

May be good in a noisy environment to get a baseline for ausculation

Ex) 120/P (palpation)

How much of the arm should a blood pressure cuff cover?

2/3 of the upper arm/humorous

Descriptive words for assessing patient skin

Hot, cold, cool, warm

Cool/Clammy

Pink, blue, gray, pale

Assessing level of consciousness

AVPU

Alert, Response to verbal stimuli, Response to painful stimuli, Unresponsive

Only one letter can be used

SAMPLE

Used to get patient history

Signs/Symptoms, Allergies, Medication, Pertinent Past, Last oral intake, Events (leading up)

OPQRST

Used to assess a sign/symptom (defines the S in sample)

Onset, Provocation, Quality, Radiation, Severity, Time

DCAPBTLS

Used to remember when evaluation a patient during an assessment

Deformities, Contusions, Abrasions, Punctures, Burns, Tenderness, Lacerations, Swelling.

Detail Assessment

Performed during the general assessment. It is a head to toe assessment done for major injuries, young patients, unresponsive, intoxicated, AMS patient's

Start at the head then throat, chest, abdomen, pelvis, legs, arms, and back. Should be done in 90 seconds or less

Sign

Something you can see, feel, touch, and can validate.

Ex) Vomiting, hypoxia, respiratory distress, etc

Symptom

Something the patient describes

Ex) Dizziness

Pupils descriptor words

Dilated, fixed, unequal, sluggish

Unequal pupils

In this course unequal pupils is a CVA (cerebral vascular accident; stroke) until proven otherwise

PEARL

Pupils equal and reactive to light. This is the normal finding.

Pupils in dark

They dilate

Pupils in light

They constrict